Healthcare Provider Details

I. General information

NPI: 1962688515
Provider Name (Legal Business Name): DODDRIDGE COUNTY BOARD OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 SISTERSVILLE PIKE
WEST UNION WV
26456-1034
US

IV. Provider business mailing address

104 SISTERSVILLE PIKE
WEST UNION WV
26456-1034
US

V. Phone/Fax

Practice location:
  • Phone: 304-624-6554
  • Fax: 304-624-5223
Mailing address:
  • Phone: 304-624-6554
  • Fax: 304-624-5223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateWV

VIII. Authorized Official

Name: KIMBERLY SUE TURNER
Title or Position: RESA VII MEDICAID COORDINATOR
Credential:
Phone: 304-624-6554